Music in the Head

Living at the Brain-Mind Border

Leo Rangell

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429916410
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book turns out to have a scientific relevance and value that will similarly interest many, not only those in the specialized field of neuroscience but very individual who has a brain and a mind and wonders about them.

CHAPTER ONE
Background to an event

Something happened

An uncommon medical event happened to me twelve years ago, which both left me with a medical problem, and presented an unusual opportunity. It is hard to pin down, although I use the term “medical” to cover the possibilities. Was it auditory, psychological, physiological, neurological, mental, a sensory aberration, or a noise or sound or tune impinging from the outside somewhere? I could say it left me with an illness, but after more than a decade of experience with it, I hesitate to call it that. I have learned to live with and know it, and I regard my life since that occurrence as living in a ringside seat at a physiological process ordinarily covered and obscured in normal life.

I am speaking of what I can call musical hallucinosis, involuntary music in the head. I hear music, at first I would say all the time. Now I qualify that. At the beginning, I described it as always there; now I say “whenever I listen”. Is it right to say it is there all the time? It is there whenever I wish to check on it. Or whenever I am not attending to, or focused upon, or thinking about, anything else. Does that make it always?

It took some time, experience, attention and discrimination to come to opinions or an understanding and a reasonable orientation. The new and complex phenomenon gradually came more under control, as it became more identifiable, localizable, predictable and understood, as well as adjusted to, more subject to influence, and finally fairly-well tolerated.

After first acknowledging it, then a period of my reacting to it, examining it, and working to develop an attitude towards it, the alien phenomenon I will describe settled into being a part of me that I increasingly had to admit was integrated into my very being. Accepting that it could come into consciousness and leave when it wished with a seeming life of its own, I also made a sort of peace with it, on terms I will try to convey and explain. Along the way, this experience wished upon me or provided me with a medical or psychological or mind-body problem that in time I came to see as presenting an unusual opportunity to study it and gain.

This book is about that bodily or mental condition or experience that has become part of me, and that I believe will reverberate to many people. It also, I believe, turns out to have a scientific relevance and value that will similarly interest many, not only those in the specialized field of neuroscience but very individual who has a brain and a mind and wonders about them.

I did say that the involuntary music comes on “whenever I wish to check”. Ordinarily, there is some interval between wishing to do something and doing it. But there is no intervening time here. The music is there the moment I have the thought of listening for it, before I can start an active process of listening. I am not even always sure that I wished to check. Often it just impinges out of the blue. Whenever I am just thinking nothing. It just seems as if it is there waiting. Waiting for me to pay it attention. Where is it? Somewhere in the distance, usually over my right shoulder. About half a mile away.

Who am I to tell it? My listening post

Before going much further, a bit about me as a point of orientation. Who am I to be telling you all this? Why should you listen? And what relevance does this have to you, the serendipitous reader, who just picks this up?

I am a psychoanalyst. I was first a neurologist, then a psychiatrist, then an analyst. That was sort of a sequence of progression in training for my profession years back. I am recounting my story, however, because it happened. And can happen to anyone. The curiosity to understand it would be there in anyone at the receiving end. Yet my more-than-half a century of studying and treating the brain and the mind, and my routine, daily effort to decipher and understand unusual experiences or behaviour in relation to these, seem to place me in a rather prepared position to peer into it, and try to make sense of all that has happened. It seems like an unusual combination and scientific possibility. But while this makes for a fortuitous observer at an unusual listening post, I also feel that it comes to have significance in a wider area of intellectual preoccupation. I have come to see this experience as throwing light on the creative process, which belongs to everyman, those who have it, or much of it, and those who aspire to have some and to use it. And it merges and shades into philosophy, an interest in the mind, body, brain and society, the links and inter-relations between inner and outer that pique every thinking man, or rather every human. My profession was born and developed in extraordinary times.

My credentials in music are not the same, in fact add up to nil. I never played a musical instrument, other than blowing on the harmonica as a boy, am not a musicologist, and am not an educated music listener. Some members of my family are musicians who make me proud, from classical music to jazz, on many instruments. A few nephews are known in serious fields, a classical pianist, a prominent saxophonist, a jazz leader, a niece vocalist, my son self-taught but a versatile, professional performer in multiple formats, in Cajun, Southwest, country music, and grandchildren who have made good starts with the violin and one as the leader of a band.

I myself am one who whistles not while he works-my occupation prevents that, even forbids it—but as soon as he finishes. My family always said they knew I was coming, and was in a good mood, when they heard me walking downstairs (my office has been upstairs) to the dinner table at the end of the day, making sounds blowing air which were rhythmic, not quite songs but approximate ones. Songs do get to me, mostly old ones, and I can sway and gyrate to them for long periods, without others knowing it.

A Congress looms

Coming back to my story, to describe more of the background and prelude that preceded “the event” that brought on the experience that I am describing in this book:

The summer of 1995 was an exciting time. I am 92 now (at the beginning of writing this, which is in 2005), and I must admit that my adult life has been exciting much of the time (this does not mean without the entire range of emotions, lows as well as highs). In July of that year, I was scheduled to address the International Psychoanalytic Congress at its opening session in San Francisco, the second such meeting in the United States in the history of the IPA (the International Psychoanalytic Association). The theme of the Congress, and the subject of my talk and a panel discussion of which it was a part, was to be on “Psychic Reality”.

Psychoanalysis, in the century of Freud, had established that ideas, feelings, fantasies, thoughts, i.e., the potpourri of mental products, are as ubiquitous, and as much determinants of human health and happiness, or illness and malfunctioning, as the somatic or physical world of the body. A dream, or fantasy, or an affect, anxiety or worry, or a feeling of guilt, or shame or depression, is a reality, an entity, although a psychic one, as much as a thing or action or event in the external “real world”.

Psychic reality and external reality share their effects on the subject who navigates between them. Humans are guided, and can be equally affected, by both. The two realms of data and experience can be of equal importance. In my early professional years, it was still new to point out, whether informing patients or teaching medical students, that an emotion, such as sudden fright, or a chronic depression can cause a heart attack, which can cause death. People can be “frightened to death”. It cannot get more serious. Today, this is common knowledge, too obvious to need to be stressed.

I was steeped in thinking about these ideas, this small segment of our theoretical system, and aiming to formulate them effectively at the Congress. The subject, of what is real, and what “real” is, turns out to be ironic for the saga that followed. To “be”, does something have to be able to be touched? The question “what is ‘to be’?” hearkens back to a similar question and answer provided by a most successful American President facing impeachment: “It depends on what sex is”.

But an issue lurks

There was a complication lurking, however, during the preparations I was engaged in prior to the meeting that I had decided to put aside for a time. About a month before the opening of the Congress, I thought I felt an increase in dyspnea on exertion, a little too much shortness of breath on walking fast, or straining, or at a sudden lurching forward faster than usual. I experienced this on several occasions, as when going up a staircase from a parking lot rather rapidly to get to a concert at the Music Centre on time. It was not severe but definite, and I felt it as a possible signal.

To explain why, it was exactly such a subjective experience that had led to my heart operation some 15 years previously. Nothing more than a slight increase of normal shortness of breath that I had felt while playing tennis, which I was not sure of but which had alerted me, and led to my having my first stress test at age 67, in 1980. The cardiologist stopped the test abruptly from what he saw on the electrocardiogram, and directed me to an angiogram. A few days later, I was in open-heart surgery. Five obstructed coronary vessels were treated by by-passes. There were no complications; the result was excellent; I was playing tennis again in a little over two weeks.

The immediate prelude

Back to the summer of 1995. On a visit to San Francisco to visit my daughter a few weeks before the International meeting to be held in that city, I had mentioned my concerns to a cardiologist friend who was her neighbour. He ventured the thought that another angiogram was in order. I agreed, but feeling that this was not an immediate threat, I elected to do this after the Congress. This was not without trepidation, but I decided to take that chance.

The meeting came and went, was as exciting as usual, a combination of exhilaration, tensions and non-stop activity. Taking a breath the next day (no pun), while still in the Bay area, I went for the test in the office of my angiographer-friend. When it was over, we sat down in his office for the results. Before presenting me with the unexpected findings, he informed me that what he would tell me would sound alarming but that I should not be alarmed. The result showed four or five vessels almost completely obstructed, the same as had preceded my first operation 15 years before.

After reeling and absorbing the news for a day or so, and mulling over the possibilities, I chose to return to Los Angeles, to have the surgery there again. This was to be with a different cardiac surgeon than before, this time in UCLA, where I was on the faculty. The previous procedure had been at Cedars-Sinai, with a surgeon who had since retired.

It is an aftermath of that second surgical experience that I wish to report and enlarge upon in this book. By serendipity, the path we will be traversing will be partly connected to those same two interwoven realities of human life, the physical and the psychological, that I just described and, as I came to experience them in a unique way, to other interesting theoretical issues of the functioning of the brain and the mind to which they led. The clinical data, rare in its content, presents an unusual opportunity. Since in this I will be the observer and the observed, my aim will be to be both objective and subjective, to be an objective reporter of subjective experience, and to convey the subjective experience of objective events.

Although it can be a difficult if not agonizing decision to submit to this surgical procedure, the choice was made easier for me by the test results. Almost complete blockage of all of my previous bypassed vessels left me with little to ponder. I had been living asymptomatically mostly on collaterals.

A related experience

It is of interest that less than a decade before my previous operation in 1980, an analytic patient of mine had undergone the first bypass operation I had known or probably heard of. I remember my countertransference at that time, my horror at the thought, my admiration of the patient, and my doubts about his judgment. I remember thinking, as debates raged about the new procedure, that certainly the new vessels would undergo the same pathological processes as the now-afflicted ones, so what was the use. I had no scientific information, just my reasoning.

As universal as trauma is, and as much as all people are affected by it, each person processes similar events in his individual ways. What had been considered shell shock in the First World War presumably due to petechial haemorrhages in the brain, became battle fatigue, then war neuroses, during World War 2. A colleague psychiatrist and psychoanalyst who was in the German Army during World War 1, Ernst Simmel, wrote at that early time that neuroses occurring at the front, however much related to battle and present danger, reflected each soldier’s individual history, his original childhood fears and terrors.

So it was with my patient and his cardiac surgery. As I had the opportunity to listen on the couch to his pre and post-operative associations, there was a remarkable confluence of traumatic dreams or fantasies as he emerged from this early instance of heart surgery, with his preoperative dreams and associations stemming from his life history. His father, a chicken dealer, would take his young son with him to the “shoichet”. The patient’s memories of his childhood were steeped in pictures of father and the schoichet cutting off the heads of chickens, removing their insides, and of blood running down the table (the scenes and ambience were to me reminiscent of the childhood and the art of Chaim Soutine). In other associations, the patient remembered being caught by his father as he was trying to look up his mother’s dress and his fear “of having everything cut off”. His picture of his mother was that of a lioness calmly “chomping” everything within sight without concern for the mayhem around her.

Materially successful and accomplished, this man was nevertheless a case of the most classical and overt castration anxiety one could see clinically. This type of psychopathology—based on one of the two basic anxieties that course through life, the other being separation anxiety—is overlooked and considered not to be present in the therapeutic climate of today, a theoretical orientation with which I (1991) take issue. The patient’s dreams, fantasies, and free associations during the years of analysis were ruminatively about castration fear, seeking out, coming close to, and then avoiding danger, and of aggressive retaliation.

In his immediate postoperative state following his heart surgery, in what was neither a dream nor fantasy, but more akin to a prolonged series of hypnopompic hallucinations during a long period of waking up, this 50-plus-year-old man went through vivid images of lying on a concrete slab, while someone opened his heart and collected the blood in large pails and buckets at the side of the table. He remembered these nightmarish anxieties during periods of revival of consciousness in three postoperative weeks that he was semi comatose. In the period that followed, he had a recurring ‘fantasydream’—i.e., a fantasy while he was awake or semi-awake and a dream when he fell asleep—in which there was a fusion between the recent surgical experience and the chicken ‘operations’ of the past. In this fantasy-dream, the patient is on a slab which he described as a combination of an operating table and the counter on which the chickens were cut. Around the table and looking down at him are the surgical team, his father and the schoichet, his wife who looks grim and sneering like his mother, and his children, his sons and daughters and their spouses, all of them in collusion. The patient is being opened up and disembowelled: a combination of a human, a chicken, and a piece of cattle. The table is tilted, the organs are thrown into a barrel nearby, and the blood drips down into a pail at the low end of the table. Periodically the pail is taken away, the blood emptied, and the pail brought back ready for more. Everything is being chopped off, his head, his limbs, his genitals. It is a continuous nightmare. The terror, which is indescribable, is followed by periods of depression and giving up. Occasionally there are moments of rest.

There were other fantasies, dreams, and associations—of being in a mortuary and smelling the embalming fluid, of riding in a railroad hospital car with bodies sticking out, of being inside an open hearth furnace. While he was said to be near death at the operation, the patient recovered fairly well, and lived 6–7 years, at which time he died of coronary disease.

Less than a decade after my patient’s account, I was to be on the same gurney, filtering the same experience through my own mind and life history. During the interval, as this type of surgery grew common, I came to know other patients’ accounts, and reports of colleagues and friends, of their hallucinatory experiences around this operative procedure. Each had his own version, linked to his life history. One colleague told how, when coming to post-operatively in the I.C.U., he was consumed with his relationship to his father, and went over countless incidents in which he now regretted his actions. Another kept experiencing visual and cognitive scenes of his being poor, homeless, and wandering about helplessly.

It was now the second time around. I saw my new heart surgeon only once, about a week before the operation, for probably no more than 15–20 minutes, during which time he put a stethoscope to my heart, and asked if I had any questions. I had none at hand. He then performed his necessary routine task of informing me that there were of course risks. There could be infection, a stroke, even death. But these were a small percentage, I looked like a good case, although this was my second bypass, and there was the matter of my age (this time just in front of 82). When I demonstrated my reaction to his input, he asked if I still wanted to go ahead, and said I could cancel if I wished. I felt his approach to be unfeeling, even cruel, but this was easily overruled by my awe and need. I said I would go ahead. I then had to sign that I knew one possible outcome was not to survive.

The Operation

I entered the hospital on a Sunday night for a Monday operation with an ease that surprised me as well as my family. I did not have any horrible memories of the former procedure 15 years before, after the angiogram that showed similar obstruction. I had been anaesthetized quite easily and woke up to cheery reports. All had gone well. By now, I probably had long repressed the anxiety and discomfort. The intervening years had conditioned me favourably to this miracle of science.

In the corridor the next morning, from my bed to the operating room, I was being given an intravenous, which had been started in my room. That was the last I remembered preoperatively. My next memory was a cognitive, kinesthetic, not so much affective one. I had made one request of the surgeon, and repeated this to the anaesthetist who had interviewed me in the hospital room the night before the surgery, the same as I had emphasized to the doctor who was to give me anaesthesia 15 years before. I gagged easily, I informed him; in fact, I had had a number of throat-spasm choking episodes on certain occasions over many years, so would he be sure to remove the intubation tube from my throat before I awoke. The reply on he previous occasion had been “of course”, and I thankfully remembered that I had had no breathing obstruction when I awoke in the intensive care unit. This time, the surgeon had said that could be arranged, but when the time came, the anaesthetist obviously heard it for the first t...